BackgroundFatigue in COPD impairs functional status; however there are few studies examining mechanistic pathways of this symptom. The aims of this study are to compare fatigue between COPD patients and healthy age-matched subjects, and to identify predictors of fatigue in COPD.MethodsSeventy four COPD patients, mean age 69.9 (49-87) yrs, mean (SD) % predicted FEV1 46.5 (20.0) % and FEV1/FVC ratio 0.45 (0.13) and 35 healthy subjects, mean age 67.1 (50-84) yrs completed the Multidimensional Fatigue Inventory (MFI 20). Patients' assessment included Depression (HADS), lung function, BMI, muscle strength, incremental shuttle walk test (ISWT), exercise oxygen saturation (SpO2), Borg breathlessness (CR-10) and exertion (RPE). Serum level of Interleukin 6 (IL-6) was recorded. Differences in MFI 20 between groups were examined and predictors of fatigue identified using logistic regression.ResultsSignificant differences (p < 0.01) were found between the COPD and healthy subjects for all MFI 20 dimensions. There were significant differences when classified according to GOLD and dyspnoea stages for selected dimensions only. Predictors of General Fatigue were depression, muscle strength and end SpO2 (R2 = .62); of Physical Fatigue: depression, % predicted FEV1, ISWT and age (R2 = .57); Reduced Activity: % predicted FEV1, BMI and depression (R2 = .36); Reduced Motivation: RPE, depression and end SpO2 (R2 = .37) and Mental Fatigue: depression and end SpO2 (R2 = .38).ConclusionAll dimensions of fatigue were higher in COPD than healthy aged subjects. Predictive factors differ according to the dimension of fatigue under investigation. COPD-RF is a multi component symptom requiring further consideration.

Introduction: Subjective fatigue has been recognised as an important, multi-component symptom in COPD. Pulmonary Rehabilitation (PR) improves fatigue component of the Chronic Respiratory Questionnaire, a quality of life (QoL) measure. However, it is not clear if all fatigue dimensions are affected equally. This study aims to evaluate changes in subjective multidimensional fatigue among people with COPD who participated in PR. Methods: Thirty seven stable COPD patients were recruited; 23 patients (15 male) mean age 68.5 (range 49e86) yrs, mean (SD) %predicted FEV 1 45.3 (19.8); completed 7 weeks of PR. Assessments (pre and post PR) consisted of the Multidimensional Fatigue Inventory (MFI-20), QoL (SGRQ), Anxiety and Depression (HADS), the London Chest Activity of Daily Living Scale (LCADL), muscle strength, incremental (ISWT) and endurance (ESWT) shuttle walk tests. The differences between pre and post PR fatigue were tested using Wilcoxon's test and relationships with other outcomes were examined using Spearman's correlation. Results: There were statistically significant improvements in Reduced Activity (RA) (p Z 0.01), General (GF) (p < 0.01) and Physical Fatigue (PF) (p Z 0.03) components of MFI-20 after PR, but there were no differences in Motivation or Mental Fatigue (p > 0.05). There were significant improvements in ISWT (p < 0.05), ESWT (p < 0.01) and muscle strength (p Z 0.03). Statistically significant correlations (p < 0.05) were found between changes in GF and in both ISWT (r Z À0.43) and SGRQ impact (r Z 0.46); and between RA and ESWT changes (r Z À0.45).

Building on the core syllabus for postgraduate training in respiratory physiotherapy, published in 2014, the European Respiratory Society (ERS) respiratory physiotherapy task force has developed a harmonised and structured postgraduate curriculum for respiratory physiotherapy training. The curriculum outlines the knowledge, skills and attitudes which must be mastered by a respiratory physiotherapist working with adult or paediatric patients, together with guidance for minimal clinical exposures, and forms of learning and assessment.This article presents the rationale, methodology and content of the ERS respiratory physiotherapy curriculum. The full curriculum can be found in the supplementary material.

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Chronic Obstructive Pulmonary Disease (COPD) is a chronic disease and major cause of disability. COPD may be considered a systemic disease, which causes an array of symptoms, one of which is the subjective sensation of fatigue. In recent years, COPD related fatigue (COPD-RF) has increasingly been recognised as an important area of research. The aim of this paper is to comprehensively review the literature concerning this topic and to summarise existing knowledge on the subjective perception of fatigue in people with COPD. This paper provides a narrative review of literature in this area. The search used the electronic databases of OVID MEDLINE and EMBASE included original studies from 1980 to December 2011. The databases were searched using the key MeSH terms COPD and Fatigue.In total 40 relevant publications were identified. This literature review covers the following areas identified by research studies: fatigue in COPD in comparison with healthy older people, gender differences, patients' experience of fatigue, prevalence of fatigue reporting in COPD, pattern and frequency of fatigue in COPD, the impact of fatigue on an individual's life, predictors of fatigue, coping and treatment strategies for the management of fatigue. Furthermore, this review identifies areas for further research and makes recommendations for clinical practice.

@ERSpublicationsThe Respiratory Physiotherapy HERMES project aims to standardise treatment of patients within and beyond Europe http://ow.ly/L1e72Best practice in the diagnosis and management of patients with respiratory conditions is now a multidisciplinary effort [1,2]. Physiotherapists engage in many aspects of the care of patients with respiratory diseases. Across a range of diseases, ages and settings, they carry out highly specialised treatments related to mucus clearance, breathing exercises, invasive and non-invasive mechanical ventilation, exercise training and rehabilitation, as well as reintegration of patients with respiratory disorders. Their tasks span from the neonatal intensive care unit to the palliative care unit of geriatric patients. Over the past decades, respiratory physiotherapists across the world have published research in all these fields feeding into the evidence base that underpins much of the care provided by these professionals. Physiotherapy practice has also evolved over the past few decades. Self-referral by service users ( patients) is now possible in approximately half of the European member states of the World Confederation on Physiotherapy [3]. This requires highly trained health professionals capable of assessing, treating, referring and reintegrating patients. In patients with respiratory conditions, this is often performed in the context of a multidisciplinary team.Physiotherapy education is not uniform across Europe and the world. Undergraduate and postgraduate programmes have undergone significant reforms towards an academic educational track (MSc and PhD) over the past decades in many countries. In other countries, physiotherapy education is still largely geared

Chronic obstructive pulmonary disease (COPD) is a disabling condition associated with progressive airflow limitation and lung tissue damage; its main symptoms are breathlessness, fatigue, cough, and sputum production. In the advanced stage of the disease, these symptoms may severely impact on a person's physical and psychological functioning, with some also developing chronic respiratory failure, associated with blood gas abnormalities. Non-pharmacological interventions can improve quality of life and functioning in the management of people living with advanced COPD. This article will provide an overview of common non-pharmacological methods used in the symptomatic management of severe COPD, including: breathlessness and fatigue management strategies, anxiety management, pulmonary rehabilitation (PR) and physical activity (PA), neuromuscular electrical stimulation (NMES), airway clearance techniques (ACTs), nutrition and non-invasive ventilation (NIV). The importance of a holistic and multi-disciplinary approach to people living with COPD will be discussed.

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